Reality Check on Health Care Reform

The Obama forces, knocked back on their heels by the raw emotions unleashed in the town halls (both by genuinely worried citizens and genuine kooks), now seem to have adopted a new tack. Again and again we’re now told that nothing really important will change under reform–or, if anything does change, all the changes will be for the better. Hurray!

“If you like your doctor, you’ll keep your doctor,” Obama now says every six minutes. “If you like your health coverage, you’ll keep your coverage.”

That sounds quite reassuring and business-as-usual,  but it seems to imply that everything else will chug along just as it has, with all the people who now have coverage, and all the millions who will get coverage  under the new plan, able to order any test or procedure they want anytime they want it,  ad infinitum.

Such a rosy scenario flies in the face of much research that says the current system encourages wasteful spending, like this study cited in a recent New York Times. Key quote:

The physicians and hospital leaders from Cedar Rapids told us how they have adopted electronic systems to improve communication among physicians and quality of care. Last year, they decided to investigate the overuse of CAT scans. They examined the data and found that in just one year 52,000 scans were done in a community of 300,000 people. A large portion of them were almost certainly unnecessary, not to mention possibly harmful, as CAT scans have about 1,000 times as much radiation exposure as a chest X-ray. (Link to full article here)

This is just one of thousands of articles you can Google that cite widespread waste and redundancy in the American system. Recall also that the other day I quoted Dr. Robert Fine, chief ethicist of the Baylor Health Systems in Dallas, who noted that approximately one-fourth of all health care spending comes in the final weeks of life, spent on treatments that do little beyond making death take a while longer.

Can that approach to medical spending be sustained–especially  after millions more people are covered? Many leading thinkers about health care say we’ve got to scrutinize the system for all kinds of wasteful spending and find some way of saying “no” to certain procedures in certain circumstances. I don’t know who the “no” sayer will be. Maybe the doctor. Maybe the patient. Maybe some Panel of Benevolent Deciders. But some mechanism will have to discourage or prohibit some expenditures, or we’ll continue to spend more than anyone else on health care while getting a dubious return on our spending.

I think the Obama people are increasingly unclear on just which health care goal they want to reach: covering the uncovered or curbing the growth of  health care spending. I’m not sure we can do both in one fell swoop, or even two or three fell swoops.

Of course we need some kind of coverage for the millions of hard-working people who now lack coverage. It just isn’t right for a man or woman to work all week at some low-paid job and then be unable to get care if the guy cuts his hand or the woman feels a lump in her breast  or the kids have been coughing for days. (Yes, I know that in many cities the uninsured can just “go to the emergency room,” but, speaking just for myself,  I’ve got other things to do than wait 15 hours before a  doctor  lances a boil.)

I don’t know what the plan would cover or how we’ll pay for it (something I have in common with many Senators), but a wealthy nation that ostensibly believes in Christian charity can and must do something for these folks.  If our  daughter gets sick,  we get her the best care we can.  It would tear us to pieces if we could not do that.  I have no reason to believe that uninsured people lack those feelings.


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